The predictive of tumour markers CA 15-3, TPS and CEA in breast cancer recurrence

Abstract

The predictive values of tumour markers Carcinoma-Associated Antigen CA 15-3, Tissue Polypeptide Specific Antigen (TPS) and Carcinoembryonic Antigen (CEA) in recurrence of breast cancer are unclear. The aim of this study was to examine the predictive value of these markers in our population of 1448 patients with diagnosed breast cancer. Data and mean follow-up of 4.4 years were available on 1082 women of whom 277 had documented recurrence (mean follow up 5.7 years). The recurrence free patients had a mean follow up of 3.9 years. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CA 15-3, TPS and CEA for visceral, bony and locoregional recurrence were calculated. CA 15-3 was the most sensitive marker, 68% for visceral and 69% for bony recurrence. This compared with TPS, 64% and 51% and CEA, 27% and 46% for visceral and bony recurrence respectively. The positive predictive value of CA 15-3 at 47% for visceral and 54% for bony recurrence was greater than that for TPS (visceral 25%, bony 21%) or CEA (visceral 18%, bony 26%). The sensitivity of CA 15-3 and TPS for locoregional recurrence was low at 23% and 17% respectively. A combination of CA 15-3, TPS and CEA failed to increase the sensitivity of CA 15-3 for visceral recurrence. However, a marginally increased sensitivity was recorded for combined CA 15-3 and TPS (70%) and for combined CA 15-3, TPS and CEA (71%) in bony recurrence. The mean lead time effect in visceral recurrence for TPS and CA 15-3 were 8 and 10 months respectively. In patients with bony recurrence the mean lead time effect for TPS and CA 15-3 were 7.5 and 8.25 months. Mean lead time effect was increased to 9 and 11 months for bony and visceral recurrence respectively when CA 15-3 and TPS were combined. CA 15-3 remains the most sensitive tumour marker in breast cancer follow up with a significantly greater positive predictive value when compared to TPS or CEA. Both TPS and CEA failed to complement the sensitivity of CA 15-3 when measured in combination.